1. US Cancer Burden Epi 242 Cancer Epidemiology Binh Goldstein, Ph.D. October 7, 2009

2. US Mortality, 2006 *Includes nephrotic syndrome and nephrosis. Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 1.Heart Diseases631,636 26.0 2.Cancer559,888 23.1 3.Cerebrovascular diseases137,119 5.7 4.Chronic lower respiratory diseases124,583 5.1 5.Accidents (unintentional injuries)121,599 5.0 6.Diabetes mellitus 72,449 3.0 7.Alzheimer disease 72,432 3.0 8.Influenza & pneumonia 56,326 2.3 9.Nephritis* 45,344 1.9 10.Septicemia 34,234 1.4 RankCause of Death No. of deaths % of all deaths

3. Change in US Death Rates* from 1991 to 2006 * Age-adjusted to 2000 US standard population. Sources: US Mortality Data, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009. 1991 2006 Rate Per 100,000

5. Age Standardized Incidence Rates US More developed countries Less developed countries SiteMalesFemalesMalesFemalesMalesFemales Lung61.936.154.917.025.99.4 Breast─101.1─67.8─23.8 Colon/Rectum44.633.140.026.610.27.7 Stomach7.23.322.310.021.510.4 Liver5.52.08.53.018.57.1 Prostate124.8─56.2─9.4─ Cervix─7.7─10.3─19.1 Esophagus4.91.36.71.312.86.5 Source: GLOBOCAN 2002

6. Ten Leading Cancer Types for New Cancer Cases 2009 Estimates Number of New Cases SiteBothMaleFemale Lung & Bronchus219,440116,090103,350 Breast194,2801,910192,370 Prostate192,280 -- Colon/Rectum146,97075,59071,380 Bladder70,98052,81018,170 Skin Melanoma68,72039,08029,640 Non-Hodgkin Lymphoma65,98035,99029,990 Kidney57,76035,43022,330 Leukemia44,79025,63019,160 Pancreas42,47021,05021,420 All Sites1,479,350766,130713,220

7. 2009 Estimated US Cancer Cases* *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, 2009. Men 766,130 Women 713,220 27%Breast 14%Lung & bronchus 10%Colon & rectum 6%Uterine corpus 4%Non-Hodgkin lymphoma 4%Melanoma of skin 4% Thyroid 3%Kidney & renal pelvis 3%Ovary 3%Pancreas 22%All Other Sites Prostate25% Lung & bronchus15% Colon & rectum10% Urinary bladder7% Melanoma of skin5% Non-Hodgkin5% lymphoma Kidney & renal pelvis5% Leukemia 3% Oral cavity3% Pancreas3% All Other Sites19%

8. Cancer Incidence Rates* by Sex, US, 1975-2005 *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008. Both Sexes Men Women Rate Per 100,000

9. Cancer Incidence Rates* Among Men, US, 1975-2005 Prostate Lung & bronchus Colon and rectum Urinary bladder Non-Hodgkin lymphoma Rate Per 100,000 Melanoma of the skin *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008.

10. Cancer Incidence Rates* Among Women, US, 1975-2005 *Age-adjusted to the 2000 US standard population and adjusted for delays in reporting. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008. Colon and rectum Rate Per 100,000 Breast Lung & bronchus Uterine Corpus Ovary Non-Hodgkin lymphoma

11. Cancer Incidence Rates* by Race and Ethnicity, 2001-2005 *Age-adjusted to the 2000 US standard population. † Person of Hispanic origin may be of any race. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Rate Per 100,000

12. Cancer Incidence Rates* by Sex and Race, US,1975-2005 *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, Delay-adjusted Incidence database: SEER Incidence Delay-adjusted Rates, 9 Registries, 1975-2005, National Cancer Institute, 2008. African American men White men White women African American women Rate Per 100,000

13. Ten Leading Cancer Types for Cancer Deaths 2009 Estimates Number of Deaths SiteBothMaleFemale Lung & Bronchus159,39088,90070,490 Colon/Rectum49,92025,24024,680 Breast40,61044040,170 Pancreas35,24018,03017,210 Prostate27,360 -- Leukemia21,87012,5909,280 Non-Hodgkin Lymphoma19,5009,8309,670 Liver18,16012,0906,070 Ovary14,600 --14,600 Esophagus14,53011,4903,040 All Sites562,340292,540269,800

14. 2009 Estimated US Cancer Deaths* ONS=Other nervous system. Source: American Cancer Society, 2009. Men 292,540 Women 269,800 26%Lung & bronchus 15%Breast 9%Colon & rectum 6%Pancreas 5%Ovary 4%Non-Hodgkin lymphoma 3%Leukemia 3%Uterine corpus 2% Liver & intrahepatic bile duct 2%Brain/ONS 25% All other sites Lung & bronchus30% Prostate9% Colon & rectum 9% Pancreas6% Leukemia4% Liver & intrahepatic4% bile duct Esophagus4% Urinary bladder3% Non-Hodgkin 3% lymphoma Kidney & renal pelvis3% All other sites 25%

15. Cancer Death Rates* by Sex, US, 1975-2005 *Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Men Both Sexes Rate Per 100,000 Women

16. Trends in the Number of Cancer Deaths Among Men and Women, US, 1930-2006 Women Men Number of Cancer Deaths Men Women Source: US Mortality Data, 1930-2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2009.

17. Cancer Death Rates* Among Men, US,1930-2005 *Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Lung & bronchus Colon & rectum Stomach Rate Per 100,000 Prostate Pancreas LiverLeukemia

18. Cancer Death Rates* Among Women, US,1930-2005 *Age-adjusted to the 2000 US standard population. Source: US Mortality Data 1960-2005, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Lung & bronchus Colon & rectum Uterus Stomach Breast Ovary Pancreas Rate Per 100,000

19. *Per 100,000, age-adjusted to the 2000 US standard population. † Persons of Hispanic origin may be of any race. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Cancer Death Rates* by Race and Ethnicity, US, 2001-2005

20. African American men White men African American women White women Rate Per 100,000 Cancer Death Rates* by Sex and Race, US, 1975-2005 *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008.

21. All sites 313.0230.71.4 Prostate 59.4 24.62.4 Larynx 4.8 2.12.3 Stomach 11.5 5.02.3 Myeloma 8.3 4.31.9 Oral cavity and pharynx 6.7 3.81.8 Small intestine 0.7 0.41.8 Liver and intrahepatic bile duct 10.3 6.71.5 Colon and rectum 31.8 22.11.4 Esophagus 9.8 7.81.3 Lung and bronchus 93.1 71.31.3 Pancreas 15.4 12.11.3 Cancer Sites in Men for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005 *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site African AmericanWhite Ratio of African American/White

22. All sites 186.7159.21.2 Stomach 5.5 2.52.2 Myeloma 6.0 2.82.1 Uterine cervix 4.7 2.32.0 Esophagus 2.8 1.61.8 Uterine corpus 7.1 3.91.8 Small intestine 0.5 0.31.7 Larynx 0.8 0.51.6 Colon and rectum22.4 15.31.5 Pancreas12.4 9.01.4 Breast 33.5 24.41.4 Gallbladder 1.0 0.81.3 Urinary bladder 2.8 2.21.3 Liver and intrahepatic bile duct 3.9 2.91.3 Cancer Sites in Women for Which African American Death Rates* Exceed White Death Rates*, US, 2001-2005 *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site African AmericanWhite Ratio of African American/White

23. * For those free of cancer at beginning of age interval. Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan Lifetime Probability of Developing Cancer, Men, 2003-2005* † All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder. SiteRisk All sites † 1 in 2 Prostate 1 in 6 Lung and bronchus1 in 13 Colon and rectum1 in 18 Urinary bladder ‡ 1 in 27 Melanoma § 1 in 39 Non-Hodgkin lymphoma1 in 45 Kidney1 in 57 Leukemia1 in 67 Oral Cavity1 in 72 Stomach1 in 90 ‡ Includes invasive and in situ cancer cases § Statistic for white men.

24. Lifetime Probability of Developing Cancer, Women, US, 2003-2005* SiteRisk All sites † 1 in 3 Breast 1 in 8 Lung & bronchus 1 in 16 Colon & rectum 1 in 20 Uterine corpus 1 in 40 Non-Hodgkin lymphoma 1 in 53 Urinary bladder ‡ 1 in 84 Melanoma § 1 in 58 Ovary 1 in 72 Pancreas 1 in 75 Uterine cervix 1 in 145 Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan * For those free of cancer at beginning of age interval. † All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder. ‡ Includes invasive and in situ cancer cases § Statistic for white women.

25. All Sites6858 10 Breast (female)9178 13 Colon 6655 11 Esophagus1811 7 Leukemia5242 10 Non-Hodgkin lymphoma6658 8 Oral cavity6242 20 Prostate9996 3 Rectum6759 8 Urinary bladder8266 16 Uterine cervix7465 9 Uterine corpus8661 25 Cancer Survival*(%) by Race,1996-2004 *5-year relative survival rates based on cancer patients diagnosed from 1996 to 2004 and followed through 2005. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site White Absolute Difference African American

26. Trends in Five-year Relative Survival (%)* Rates, US, 1975-2004 *5-year relative survival rates based on follow up of patients through 2005. Source: Surveillance, Epidemiology, and End Results Program, 1975-2005, Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Site1975-1977 1984-1986 1996-2004 All sites505466 Breast (female)757989 Colon 525965 Leukemia354251 Lung and bronchus131316 Melanoma828792 Non-Hodgkin lymphoma485365 Ovary3740 46 Pancreas33 5 Prostate697699 Rectum495767 Urinary bladder747881

27. Tobacco Use in the US, 1900-2005 *Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Data, 1960-2005, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. Cigarette consumption: US Department of Agriculture, 1900-2007. Per capita cigarette consumption Male lung cancer death rate Female lung cancer death rate

28. Trends in Cigarette Smoking Prevalence* (%), by Sex, Adults 18 and Older, US, 1965-2007 *Redesign of survey in 1997 may affect trends. Source: National Health Interview Survey, 1965-2007, National Center for Health Statistics, Centers for Disease Control and Prevention, 2008. Men Women

29. Trends in Obesity* Prevalence (%), Children and Adolescents, by Age Group, US, 1971-2006 *Body mass index (BMI) at or above the sex-and age-specific 95 th percentile BMI cutoff points from the 2000 sex- specific BMI-for-age CDC Growth Charts. Note: Previous editions of Cancer Statistics used the term “overweight” to describe youth in this BMI category. Source: National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003-2006: Ogden CL, et al. High Body Mass Index for Age among US Children and Adolescents, 2003-2006. JAMA 2008; 299 (20): 2401-05.

30. Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2006 † *Obesity is defined as a body mass index of 30 kg/m 2 or greater. † Age adjusted to the 2000 US standard population. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003- 2004, 2005-2006: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, 2005-2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007.

31. Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2006 † *Obesity is defined as a body mass index of 30 kg/m 2 or greater. † Age adjusted to the 2000 US standard population. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002, 2004. 2003- 2004, 2005-2006: National Health and Nutrition Examination Survey Public Use Data Files, 2003-2004, 2005-2006, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006, 2007.

32. Trends in Overweight* Prevalence (%), Adults 18 and Older, US, 1992-2007 19921995 1998 Less than 50%50 to 55%More than 55%State did not participate in survey *Body mass index of 25.0 kg/m 2 or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998) and Public Use Data Tape (2004-2007), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005, 2007, 2008. 2007

33. Screening Guidelines for the Early Detection of Breast Cancer, American Cancer Society  Yearly mammograms are recommended starting at age 40.  A clinical breast exam should be part of a periodic health examination, about every 3 years for women in their 20s and 30s. Asymptomatic women aged 40 and older should continue to undergo a clinical breast exam, preferably annually*.  Beginning in their early 20s, women should be told about the benefits and limitations of breast-self examination. Women should know how their breasts normally feel and report any breast changes promptly to their health care providers. __________ * Beginning at age 40 years, annual CBE should be performed prior to mammography

34. Mammogram Prevalence (%), by Educational Attainment and Health Insurance Status, Women 40 and Older, US, 1991-2006 *A mammogram within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data Tape (2000, 2002, 2004, 2006), National Centers for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007. Women with less than a high school education Women with no health insurance All women 40 and older

35. Screening Guidelines for the Early Detection of Cervical Cancer, American Cancer Society  Screening should begin approximately three years after a women begins having vaginal intercourse, but no later than 21 years of age.  Screening should be done every year with regular Pap tests or every two years using liquid-based tests.  At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years with cervical cytology (either conventional or liquid-based Pap test) alone, or every 3 years with a human papillomavirus DNA test plus cervical cytology.  Women 70 and older who have had three or more consecutive Pap tests in the last ten years may choose to stop cervical cancer screening.  Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.

36. Trends in Recent* Pap Test Prevalence (%), by Educational Attainment and Health Insurance Status, Women 18 and Older, US, 1992-2006 * A Pap test within the past three years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Educational attainment is for women 25 and older. Source: Behavior Risk Factor Surveillance System CD-ROM (1984-1995, 1996-1997, 1998, 1999) and Public Use Data Tape (2000, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention, 1997, 1999, 2000, 2000, 2001, 2003, 2005, 2007. Women with no health insurance Women with less than a high school education All women 18 and older

37. Screening Guidelines for the Early Detection of Colorectal Cancer and Adenomas, American Cancer Society 2008 Beginning at age 50, men and women should follow one of the following examination schedules:  A flexible sigmoidoscopy (FSIG) every five years  A colonoscopy every ten years  A double-contrast barium enema every five years  A Computerized Tomographic (CT) colonography every five years  A guaiac-based fecal occult blood test (FOBT) or a fecal immunochemical test (FIT) every year  A stool DNA test (interval uncertain)  Tests that detect adenomatous polyps and cancer  Tests that primarily detect cancer People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule

38. Trends in Recent* Fecal Occult Blood Test Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US, 1997-2006 *A fecal occult blood test within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007.

39. Trends in Recent* Flexible Sigmoidoscopy or Colonoscopy Prevalence (%), by Educational Attainment and Health Insurance Status, Adults 50 Years and Older, US, 1997-2006 *A flexible sigmoidoscopy or colonoscopy within the past ten years. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System CD-ROM (1996-1997, 1999) and Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention and Prevention, 1999, 2000, 2002, 2003, 2005, 2007.

40. Screening Guidelines for the Early Detection of Prostate Cancer, American Cancer Society  Beginning at age 50, to men who have a life expectancy of at least 10 years, health care providers should discuss the potential benefits and limitations of prostate cancer early detection testing with men and offer the PSA blood test and the digital rectal examination.* ___________ * Information should be provided to men regarding the benefits and limitations of testing so that an informed decision concerning testing can be made with the clinician’s assistance.

41. Recent* Prostate-Specific Antigen (PSA) Test Prevalence (%), by Educational Attainment and Health Insurance Status, Men 50 Years and Older, US, 2001-2006 *A prostate-specific antigen (PSA) test within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005, 2007.

42. Recent* Digital Rectal Examination (DRE) Prevalence (%), by Educational Attainment and Health Insurance Status, Men 50 Years and Older, US, 2001-2006 *A digital rectal examination (DRE) within the past year. Note: Data from participating states and the District of Columbia were aggregated to represent the United States. Source: Behavioral Risk Factor Surveillance System Public Use Data Tape (2001, 2002, 2004, 2006), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 2002, 2003, 2005, 2007.

43. Resources American Cancer Society Cancer Facts & Figures www.cancer.org